Master plan
creates a unique
urban landmark
and innovative
healthcare system
Shanghai International Medical City

An innovative rethinking of the conventional hospital campus captured the commission for a brand new
medical complex in Shanghaiâ&#x20AC;&#x2122;s Hongqiao district.
Intended to serve not just local residents but a national
and international clientele, the campus is super scale:
a 77-acre site, five million square feet, 3,000 beds, five
hospitals and specialty clinics.
Central to the master plan is the core support facility,
which will enable the siteâ&#x20AC;&#x2122;s private and public medical
groups to share state-of-the-art diagnostic equipment,
and eliminate the expense of each hospital and clinic
providing its own. With strategies to deliver a gardenlike setting and design breakthroughs that will provide
a carbon neutral site, the campus establishes an oasis
of healing and a civic amenity in an intensely urban
environment.

Kevin Kim: The Chinese government
wants Shanghai, which is becoming
a truly international city, to replace
Hong Kong as their center of finance
and technology. To make this happen, they have to attract top-level
talent from all over the world, as
Hong Kong does now. That means
providing a higher standard of living
in the city.
Compared to Hong Kong, Singapore
and other major Asian cities,
Shanghai, and really all of China,
is lacking quality healthcare services.
When ex-pats, especially well-to-do
foreigners, get sick, they usually
fly out of the country for care. The
goal of the Shanghai medical city is
to be an experimental showcase for
China’s healthcare future.
Beyond the healthcare-related goals,
the government also wants a landmark—not just another medical
center, but something unique. Part
of achieving that goal is creating a
park-like campus that minimizes
the institutional feel and dispels the
idea that hospitals are only places
for the sick.
What are the components
of the medical city?

David Stewart: There’s an administration building for personnel who
will oversee the whole campus, and

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then there are the separate hospitals. Huashan, an existing Shanghai
hospital, will have a facility here
focusing on neurological medicine,
neurosurgery and dermatology, as
well as a minor portion that acts like
a general hospital.
Kevin: Another hospital is for cancer
treatment. Then there’s an international hospital that serves as a general hospital for medical tourism or
those who are privately insured.
David: One thing we’ve learned is
that medical tourism isn’t just people
coming from the United States or
other countries to have surgery because they can do so for a lower cost
in China. It’s also people coming to
Shanghai from other cities within
China for special procedures. The
campus is about five miles from
a central transportation hub with
an airport, highspeed rail and other transit modes, which improves
accessibility.
Explain the role of what you call the
“shared facility” at the center of the site.

Kevin: Let’s say the Chinese government wants to bring in a worldrenowned orthopedic hospital or
cutting-edge heart hospital someday.
If the specialty hospitals have to
build a complete facility from scratch,
the large investment in capital and
time would make it a very unattractive proposition.

The master plan calls for the
development of approximately five
million square feet of healthcare
space to accommodate 3,000 beds
and support space dispersed among
five hospitals, multiple specialty
clinics and a core support facility.
The campus shares boundaries
with multiple transportation hubs.
Studies of traffic and circulation
patterns have been addressed
through facility placement and
interior roadway designs.

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1A - Shared Facility

The shared facility is the central
distribution point for all logistical
services—food, laundry, supplies—as
well as the location of the latest diagnostic technology, treatment centers,
even surgery. The orthopedic hospital
would simply need to send experts
and doctors, and build out a medical
office in the specialty clinic building.
They will use the shared facility for
diagnostic and treatment needs and
won’t need their own MRIs, x-ray and
CT scan machines. The advantage is
that you can have cutting-edge, expensive technology—something that
maybe an individual hospital could
not afford on its own—and everyone
can share it.
This sounds very rational for medical
cost controls, which is perhaps
why it also sounds revolutionary.

Kevin: Having multiple hospitals
plug into a shared service facility is
a new concept. I don’t think there’s
a similar case anywhere in the world.
What’s especially difficult is figuring
out how this would work because the
Shanghai campus will be a mixture
of public and private hospitals.
In the United States, all the hospitals
would have to come together voluntarily and create a shared facility.

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1B - Huashan Hospital

It would be an unusual and difficult scenario. It’s possible in China
because the government there is
very strong and does a lot of central
planning.
Huashan is public?

Kevin: Yes, but the cancer, international hospitals and shared facilities
would be private. All the specialty
clinics would be private. The question is how do you mix public and
private, non-profit and for-profit?
How do you manage this thing? It’s
a good idea, but what’s the liability
and how do you share the profit?
These are real life issues, and that’s
what they’re in the process of figuring out.
Have you had experience with
a medical operation this big?

1C - Cancer Hospital

usually piece-by-piece additions over
20 years. Here they’re condensing all
that into a very short time period—a
ten-year build-out from scratch.
GS&P was awarded this project
as the result of a competition. I
assume it was international?

Kevin: Yes, there were four teams:
one from Japan, one from Germany
and one Swiss.
David: The Chinese thought our
scheme was the best, but a lot of
it is also developing relationships.
Our first involvement was a feasibility study two years ago that was
featured in Showcase 2. Since then
we’ve developed the site master plan
and worked through more detail on
the specifics of the project, so it has
evolved over time.

David: We work on medical campuses of this size all the time, but

...a shared facility is a new concept...
...there’s [not] a similar case
anywhere in the world.

1D-G - Specialty Hospitals

2 - International Hospital

3 - Long-Term Patient Care and Retail

The master plan is organized to allow for phased design and
construction over a ten-year span.

The platform or public plaza is essentially a roof garden that slopes
up from the edge to three stories above street level, with two
functioning stories and parking beneath.

TOP: Outpatient lobbies are highlighted by skylights and
a curtainwall that provide an abundance of natural light
and a strong connection to the campusâ&#x20AC;&#x2122; park-like setting.
ABOVE:Luxurious VIP suites include private nurses, a
concierge, special food service and suite space for families.

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O

f all building types, hospitals are among the highest in terms
of energy consumption. Shanghai International Medical
City strives to be the world’s most energy efficient healthcare
campus by generating, conserving and recycling energy.

GENERATE
the campus is
designed to generate
its own energy
utilizing photovoltaic
panels, geothermal
heat exchange and
biomass systems.

CONSERVE
it will conserve energy
by utilizing high
performance lighting,
hvac equipment,
building envelope
and a vegetative roof
system.

RECYCLE
energy will be
recycled by capturing
and reclaiming energy
from building exhaust,
rainwater harvesting,
gray water and turbine
exhaust.

the platform concept, in which
the five main facilities connect on
subterranean levels topped by a
public plaza, seems to have been
key to the organization of the site.
how did the concept evolve?

Brent Hughes: We were having a lot
of trouble organizing site circulation strictly in plan. We didn’t have
enough acreage to accommodate
separate inpatient and outpatient
entrances and paths, nor for separate parking for staff, inpatients and
outpatients without then having no
space left for public and park space.
Frank Swaans: Chinese building
codes also mandate more stairs and
elevators than the United States,
which increases the space needed
for circulation.
Brent: Separating inpatients and
outpatients isn’t a big deal in the
Unites States, where we have many
freestanding outpatient facilities. In
China, however, it’s a major concern
because these tend to be grouped
with hospitals, so there’s a very large
number of outpatients coming to a
hospital for treatment. Separating
those two circulation paths was important, and the only way we could
effectively accomplish it was with a
sectional solution—by layering.
Kevin: The platform or public plaza
is essentially a rooftop garden that
slopes up from the edge to three

Kevin: Outpatients enter at streetlevel and are kept to the perimeter
as much as possible. Inpatients enter from the platform to the shared
facility at the center. They can then
move to the surrounding hospitals
via paths underneath the platform.
Medical staff and service workers
also move underneath the platform.
This “off-stage” circulation is out
of public sight to minimize the institutional feel and maximize the
park-like setting.
Frank: We estimate there will be
18,000 workers on the site at full
buildout. Paired with the thousands of outpatients, this is a lot
of people.
Kevin: That’s why the circulation
solution is so important. We need
to keep all the facilities connected,
but we don’t want people to feel
like they’re under the platform. So
we cut light wells into the platform
to provide natural light to a large
sunken garden. We organized most
of the offices and patient circulation
along this sunken courtyard.

Frank, as the planner on the team,
what challenges kept you up nights?

facility, period. In the United States
we have isolation rooms.

Frank: Well, certain idiosyncrasies in
programming for Chinese medicine.
In a Chinese hospital, for example,
50-60% of revenue comes from the
pharmacy. This percentage is much
greater than in the United States, so
we have to account for a considerably
larger pharmacy in the program.

The Chinese also sometimes express
a desire for natural ventilation; in
the United States all buildings are
fully pressurized.

Another cultural difference is that
in China, it’s very common to offer a multi-care delivery system in
which you have very luxurious VIP
suites as well as three- and four-bed
wards. The high-end care is much
different than in the United States:
private nurses, a concierge, special
food service, suite space for families.
In the United States it’s generally
equal access.
China requires separate kitchens
for patients, staff and public that
cannot be shared. In reaction to
the SARS scare of some years ago,
all infectious patients, inpatient or
outpatient, must go to a separate

So it’s a balancing act between their
codes requirements and what the
Chinese want to import from western medicine, to push the envelope
in healthcare delivery. It really challenges your creativity.
Speaking of a balancing act, how does
your master plan harmonize distinct
design identities for each facility with
the sense of a unified campus?

Kevin: The biggest unifier is the park
setting—the common platform with
its trees and landscaping.
Was the park part of the
Chinese program?

Kevin: No, we promoted the park to
them, and it’s not just for medical
staff and patients. It’s open to the

...the clients want you to push the
envelope. They allow you to plan
and design with freedom...

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JUDGES’ COMMENTS

showcase 4

gresham, smith and partners

The Shanghai International Medical City will serve as a landmark project for the city of
Shanghai. The new campus seeks to dispel the idea that a hospital is a place for the sick
by creating a serene garden-like environment that instead creates an oasis for healing.

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JUDGES’ COMMENTS

“...the design is bold and powerful
in its expression.”

public, especially on the north side
with the administration building
and the plaza. Adjacent to this side
the city is developing a commercial
center with lots of offices and a retail street. We expect some of these
people will come to the site, maybe
during their lunch hour, and use the
plaza. There will also be a food court
on top of the shared facility.
David: ...as well as a conference center, classrooms and general retail.
So the medical campus will look
very green. How green will the site
be in terms of sustainability?

Brent: We proposed, and the client
agreed, to plan for a carbon neutral
site. We got to a 77% reduction in
energy usage. Then we paused because we didn’t think we could go
further in ways that were economically feasible.

captured waste. For example, we
will re-utilize rainwater from heat
systems. Instead of treating garbage
as typical waste product, it was used
to our advantage, using the methane
gas it produces as a fuel source. It’s
tried and true technology but we’re
using it in a new application.
We ultimately got to a 95% reduction.
How much of that will survive the
real costs phase, I don’t know, but
it’s a good starting point.

financial sense of what’s feasible and
what’s not, but they’re willing to push
the limits significantly more.
Kevin: In China, there’s another
motivation: an expression of status
as a form of nationality. Look at how
much they spent on the Olympics
in Beijing. This is very similar—a
unique healthcare campus they can
show off to other countries.
David: They’re putting their stamp
on the world. 

What about this project could have
applications outside of China?

Kevin: Not only are we designing a
much larger-scale campus than is
typical, but the concept of the shared
facility could apply elsewhere. How
that could potentially bring together
a wide variety of expertise without
necessarily building separate hospitals for each is definitely pushing the
envelope in healthcare delivery.

For example?

Brent: Photovoltaics—solar panels—
where we were looking at a 30-year
payback on 20-year technology.
Kevin: And Shanghai is usually
overcast.

Frank: From my perspective, what’s
special about the Shanghai project
is that the clients want you to push
the envelope. They allow you to plan
and design with a freedom that we’re
not often given in the U.S.
Why is that true?

Brent: But the client consensus was:
Try to do the most that you can anyway. If this is going to be a landmark
project, pull out all the stops. So we
added cutting-edge elements with

David: In the U.S., whether the client is for-profit or non-profit, all
are looking at the bottom line and
the schedule. In China, they have a

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ARCHITEC TURE

ENGINEERING

INTERIORS

PLANNING

Gresham, Smith and Partners provides design and consulting solutions for the
built environment that contribute to the success of national and international
clients. For more than 40 years, GS&P has focused on enhancing quality of
life and sustainability within communities. GS&P consists of industry-leading
professionals practicing architecture and engineering design as well as
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